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. 2005 Dec;81(962):734–740. doi: 10.1136/pgmj.2004.028274

Diabetes in African Americans

M Marshall 1
PMCID: PMC1743410  PMID: 16344294

Abstract

African Americans have a high risk for type 2 diabetes. Genetic traits, the prevalence of obesity, and insulin resistance all contribute to the risk of diabetes in the African American community. African Americans have a high rate of diabetic complications, because of poor glycaemic control and racial disparities in health care in the USA. African Americans with diabetes may have an atypical presentation that simulates type 1 diabetes, but then their subsequent clinical course is typical of type 2 diabetes. Culturally sensitive strategies, structured disease management protocols, and the assistance of nurses, diabetic educators, and other health care professionals are effective in improving the outcome of diabetes in the African American community.

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Selected References

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  1. Agrawal L., Emanuele N. V., Abraira C., Henderson W. G., Levin S. R., Sawin C. T., Silbert C. K., Nuttall F. Q., Comstock J. P., Colwell J. A. Ethnic differences in the glycemic response to exogenous insulin treatment in the Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM). Diabetes Care. 1998 Apr;21(4):510–515. doi: 10.2337/diacare.21.4.510. [DOI] [PubMed] [Google Scholar]
  2. Apedo Margaret T., Sowers James R., Banerji Mary Ann. Cardiovascular disease in adolescents with type 2 diabetes mellitus. J Pediatr Endocrinol Metab. 2002 Apr;15 (Suppl 1):519–523. [PubMed] [Google Scholar]
  3. Arfken C. L., Reno P. L., Santiago J. V., Klein R. Development of proliferative diabetic retinopathy in African-Americans and whites with type 1 diabetes. Diabetes Care. 1998 May;21(5):792–795. doi: 10.2337/diacare.21.5.792. [DOI] [PubMed] [Google Scholar]
  4. Banerji M. A., Chaiken R. L., Huey H., Tuomi T., Norin A. J., Mackay I. R., Rowley M. J., Zimmet P. Z., Lebovitz H. E. GAD antibody negative NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4. Flatbush diabetes. Diabetes. 1994 Jun;43(6):741–745. doi: 10.2337/diab.43.6.741. [DOI] [PubMed] [Google Scholar]
  5. Banerji M. A., Chaiken R. L., Lebovitz H. E. Long-term normoglycemic remission in black newly diagnosed NIDDM subjects. Diabetes. 1996 Mar;45(3):337–341. doi: 10.2337/diab.45.3.337. [DOI] [PubMed] [Google Scholar]
  6. Banerji M. A., Lebovitz H. E. Insulin action in black Americans with NIDDM. Diabetes Care. 1992 Oct;15(10):1295–1302. doi: 10.2337/diacare.15.10.1295. [DOI] [PubMed] [Google Scholar]
  7. Banerji Mary Ann. Diabetes in African Americans: unique pathophysiologic features. Curr Diab Rep. 2004 Jun;4(3):219–223. doi: 10.1007/s11892-004-0027-3. [DOI] [PubMed] [Google Scholar]
  8. Banerji Mary Ann. Impaired beta-cell and alpha-cell function in African-American children with type 2 diabetes mellitus--"Flatbush diabetes". J Pediatr Endocrinol Metab. 2002 Apr;15 (Suppl 1):493–501. [PubMed] [Google Scholar]
  9. Baschetti R. Diabetes epidemic in newly westernized populations: is it due to thrifty genes or to genetically unknown foods? J R Soc Med. 1998 Dec;91(12):622–625. doi: 10.1177/014107689809101203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Beckman Joshua A., Creager Mark A., Libby Peter. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002 May 15;287(19):2570–2581. doi: 10.1001/jama.287.19.2570. [DOI] [PubMed] [Google Scholar]
  11. Bloomgarden Zachary T. Type 2 diabetes in the young: the evolving epidemic. Diabetes Care. 2004 Apr;27(4):998–1010. doi: 10.2337/diacare.27.4.998. [DOI] [PubMed] [Google Scholar]
  12. Bonds Denise E., Zaccaro Daniel J., Karter Andrew J., Selby Joe V., Saad Mohammed, Goff David C., Jr Ethnic and racial differences in diabetes care: The Insulin Resistance Atherosclerosis Study. Diabetes Care. 2003 Apr;26(4):1040–1046. doi: 10.2337/diacare.26.4.1040. [DOI] [PubMed] [Google Scholar]
  13. Bradshaw Beulah. The role of the family in managing therapy in minority children with type 2 diabetes mellitus. J Pediatr Endocrinol Metab. 2002 Apr;15 (Suppl 1):547–551. [PubMed] [Google Scholar]
  14. Burroughs Valentine J., Maxey Randall W., Levy Richard A. Racial and ethnic differences in response to medicines: towards individualized pharmaceutical treatment. J Natl Med Assoc. 2002 Oct;94(10 Suppl):1–26. [PMC free article] [PubMed] [Google Scholar]
  15. Caballero A. Enrique. Endothelial dysfunction, inflammation, and insulin resistance: a focus on subjects at risk for type 2 diabetes. Curr Diab Rep. 2004 Aug;4(4):237–246. doi: 10.1007/s11892-004-0074-9. [DOI] [PubMed] [Google Scholar]
  16. Carnethon Mercedes R., Palaniappan Latha P., Burchfiel Cecil M., Brancati Frederick L., Fortmann Stephen P. Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults: the atherosclerosis risk in communities study: 1987-1998. Diabetes Care. 2002 Aug;25(8):1358–1364. doi: 10.2337/diacare.25.8.1358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Chaiken R. L., Banerji M. A., Huey H., Lebovitz H. E. Do blacks with NIDDM have an insulin-resistance syndrome? Diabetes. 1993 Mar;42(3):444–449. doi: 10.2337/diab.42.3.444. [DOI] [PubMed] [Google Scholar]
  18. Chalew S. A., Gomez R., Butler A., Hempe J., Compton T., Mercante D., Rao J., Vargas A. Predictors of glycemic control in children with type 1 diabetes: the importance of race. J Diabetes Complications. 2000 Mar-Apr;14(2):71–77. doi: 10.1016/s1056-8727(00)00072-6. [DOI] [PubMed] [Google Scholar]
  19. Chin M. H., Zhang J. X., Merrell K. Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization. Diabetes Care. 1998 Jul;21(7):1090–1095. doi: 10.2337/diacare.21.7.1090. [DOI] [PubMed] [Google Scholar]
  20. Clark L. T., Ferdinand K. C., Flack J. M., Gavin J. R., 3rd, Hall W. D., Kumanyika S. K., Reed J. W., Saunders E., Valantine H. A., Watson K. Coronary heart disease in African Americans. Heart Dis. 2001 Mar-Apr;3(2):97–108. doi: 10.1097/00132580-200103000-00007. [DOI] [PubMed] [Google Scholar]
  21. Cook C. B., Lyles R. H., El-Kebbi I., Ziemer D. C., Gallina D. L., Dunbar V. G., Phillips L. S. The potentially poor response to outpatient diabetes care in urban African-Americans. Diabetes Care. 2001 Feb;24(2):209–215. doi: 10.2337/diacare.24.2.209. [DOI] [PubMed] [Google Scholar]
  22. Cook C. B., Ziemer D. C., El-Kebbi I. M., Gallina D. L., Dunbar V. G., Ernst K. L., Phillips L. S. Diabetes in urban African-Americans. XVI. Overcoming clinical inertia improves glycemic control in patients with type 2 diabetes. Diabetes Care. 1999 Sep;22(9):1494–1500. doi: 10.2337/diacare.22.9.1494. [DOI] [PubMed] [Google Scholar]
  23. Cossrow Nicole, Falkner Bonita. Race/ethnic issues in obesity and obesity-related comorbidities. J Clin Endocrinol Metab. 2004 Jun;89(6):2590–2594. doi: 10.1210/jc.2004-0339. [DOI] [PubMed] [Google Scholar]
  24. Dagogo-Jack Samuel. Ethnic disparities in type 2 diabetes: pathophysiology and implications for prevention and management. J Natl Med Assoc. 2003 Sep;95(9):774, 779-89. [PMC free article] [PubMed] [Google Scholar]
  25. Davidson Mayer B. Effect of nurse-directed diabetes care in a minority population. Diabetes Care. 2003 Aug;26(8):2281–2287. doi: 10.2337/diacare.26.8.2281. [DOI] [PubMed] [Google Scholar]
  26. DeFronzo R. A. Pharmacologic therapy for type 2 diabetes mellitus. Ann Intern Med. 1999 Aug 17;131(4):281–303. doi: 10.7326/0003-4819-131-4-199908170-00008. [DOI] [PubMed] [Google Scholar]
  27. Derosa Giuseppe, Cicero Arrigo F. G., Gaddi Antonio, Ragonesi Pietro D., Fogari Elena, Bertone Gianandrea, Ciccarelli Leonardina, Piccinni Mario N. Metabolic effects of pioglitazone and rosiglitazone in patients with diabetes and metabolic syndrome treated with glimepiride: a twelve-month, multicenter, double-blind, randomized, controlled, parallel-group trial. Clin Ther. 2004 May;26(5):744–754. doi: 10.1016/s0149-2918(04)90074-4. [DOI] [PubMed] [Google Scholar]
  28. El-Kebbi Imad M., Cook Curtiss B., Ziemer David C., Miller Christopher D., Gallina Daniel L., Phillips Lawrence S. Association of younger age with poor glycemic control and obesity in urban african americans with type 2 diabetes. Arch Intern Med. 2003 Jan 13;163(1):69–75. doi: 10.1001/archinte.163.1.69. [DOI] [PubMed] [Google Scholar]
  29. El-Kebbi Imad M., Cook Curtiss B., Ziemer David C., Miller Christopher D., Gallina Daniel L., Phillips Lawrence S. Association of younger age with poor glycemic control and obesity in urban african americans with type 2 diabetes. Arch Intern Med. 2003 Jan 13;163(1):69–75. doi: 10.1001/archinte.163.1.69. [DOI] [PubMed] [Google Scholar]
  30. Falkner Bonita. Insulin resistance in African Americans. Kidney Int Suppl. 2003 Feb;(83):S27–S30. doi: 10.1046/j.1523-1755.63.s83.7.x. [DOI] [PubMed] [Google Scholar]
  31. Fanelli Carmine G., Pampanelli Simone, Porcellati Francesca, Rossetti Paolo, Brunetti Paolo, Bolli Geremia B. Administration of neutral protamine Hagedorn insulin at bedtime versus with dinner in type 1 diabetes mellitus to avoid nocturnal hypoglycemia and improve control. A randomized, controlled trial. Ann Intern Med. 2002 Apr 2;136(7):504–514. doi: 10.7326/0003-4819-136-7-200204020-00007. [DOI] [PubMed] [Google Scholar]
  32. Ford Earl S., Giles Wayne H., Dietz William H. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356–359. doi: 10.1001/jama.287.3.356. [DOI] [PubMed] [Google Scholar]
  33. Franz M. J., Warshaw H., Daly A. E., Green-Pastors J., Arnold M. S., Bantle J. Evolution of diabetes medical nutrition therapy. Postgrad Med J. 2003 Jan;79(927):30–35. doi: 10.1136/pmj.79.927.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Gaskin R. Diet, diabetes, hypertension and blacks. Ethn Dis. 1999 Spring-Summer;9(2):272–277. [PubMed] [Google Scholar]
  35. Goran Michael I., Bergman Richard N., Cruz Martha L., Watanabe Richard. Insulin resistance and associated compensatory responses in african-american and Hispanic children. Diabetes Care. 2002 Dec;25(12):2184–2190. doi: 10.2337/diacare.25.12.2184. [DOI] [PubMed] [Google Scholar]
  36. Gu K., Cowie C. C., Harris M. I. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971-1993. Diabetes Care. 1998 Jul;21(7):1138–1145. doi: 10.2337/diacare.21.7.1138. [DOI] [PubMed] [Google Scholar]
  37. Haffner S. M., D'Agostino R., Saad M. F., Rewers M., Mykkänen L., Selby J., Howard G., Savage P. J., Hamman R. F., Wagenknecht L. E. Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites. The Insulin Resistance Atherosclerosis Study. Diabetes. 1996 Jun;45(6):742–748. doi: 10.2337/diab.45.6.742. [DOI] [PubMed] [Google Scholar]
  38. Haffner S. M., Howard G., Mayer E., Bergman R. N., Savage P. J., Rewers M., Mykkänen L., Karter A. J., Hamman R., Saad M. F. Insulin sensitivity and acute insulin response in African-Americans, non-Hispanic whites, and Hispanics with NIDDM: the Insulin Resistance Atherosclerosis Study. Diabetes. 1997 Jan;46(1):63–69. doi: 10.2337/diab.46.1.63. [DOI] [PubMed] [Google Scholar]
  39. Hall W. Dallas, Clark Luther T., Wenger Nanette K., Wright Jackson T., Jr, Kumanyika Shiriki K., Watson Karol, Horton Ella W., Flack John M., Ferdinand Keith C., Gavin James R., 3rd The Metabolic Syndrome in African Americans: a review. Ethn Dis. 2003 Fall;13(4):414–428. [PubMed] [Google Scholar]
  40. Harris M. I., Eastman R. C., Cowie C. C., Flegal K. M., Eberhardt M. S. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999 Mar;22(3):403–408. doi: 10.2337/diacare.22.3.403. [DOI] [PubMed] [Google Scholar]
  41. Harris M. I., Flegal K. M., Cowie C. C., Eberhardt M. S., Goldstein D. E., Little R. R., Wiedmeyer H. M., Byrd-Holt D. D. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care. 1998 Apr;21(4):518–524. doi: 10.2337/diacare.21.4.518. [DOI] [PubMed] [Google Scholar]
  42. Harris M. I. Racial and ethnic differences in health care access and health outcomes for adults with type 2 diabetes. Diabetes Care. 2001 Mar;24(3):454–459. doi: 10.2337/diacare.24.3.454. [DOI] [PubMed] [Google Scholar]
  43. Harris Maureen I., Cowie Catherine C., Gu Ken, Francis Mildred E., Flegal Katherine, Eberhardt Mark S. Higher fasting insulin but lower fasting C-peptide levels in African Americans in the US population. Diabetes Metab Res Rev. 2002 Mar-Apr;18(2):149–155. doi: 10.1002/dmrr.273. [DOI] [PubMed] [Google Scholar]
  44. Heisler Michele, Smith Dylan M., Hayward Rodney A., Krein Sarah L., Kerr Eve A. Racial disparities in diabetes care processes, outcomes, and treatment intensity. Med Care. 2003 Nov;41(11):1221–1232. doi: 10.1097/01.MLR.0000093421.64618.9C. [DOI] [PubMed] [Google Scholar]
  45. Inzucchi Silvio E. Oral antihyperglycemic therapy for type 2 diabetes: scientific review. JAMA. 2002 Jan 16;287(3):360–372. doi: 10.1001/jama.287.3.360. [DOI] [PubMed] [Google Scholar]
  46. Karter Andrew J., Ferrara Assiamira, Liu Jennifer Y., Moffet Howard H., Ackerson Lynn M., Selby Joe V. Ethnic disparities in diabetic complications in an insured population. JAMA. 2002 May 15;287(19):2519–2527. doi: 10.1001/jama.287.19.2519. [DOI] [PubMed] [Google Scholar]
  47. Keyserling Thomas C., Samuel-Hodge Carmen D., Ammerman Alice S., Ainsworth Barbara E., Henríquez-Roldán Carlos F., Elasy Tom A., Skelly Anne H., Johnston Larry F., Bangdiwala Shrikant I. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Diabetes Care. 2002 Sep;25(9):1576–1583. doi: 10.2337/diacare.25.9.1576. [DOI] [PubMed] [Google Scholar]
  48. Kimm Sue Y. S., Glynn Nancy W., Kriska Andrea M., Barton Bruce A., Kronsberg Shari S., Daniels Stephen R., Crawford Patricia B., Sabry Zak I., Liu Kiang. Decline in physical activity in black girls and white girls during adolescence. N Engl J Med. 2002 Sep 5;347(10):709–715. doi: 10.1056/NEJMoa003277. [DOI] [PubMed] [Google Scholar]
  49. Koro Carol E., Bowlin Steven J., Bourgeois Nancy, Fedder Donald O. Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report. Diabetes Care. 2004 Jan;27(1):17–20. doi: 10.2337/diacare.27.1.17. [DOI] [PubMed] [Google Scholar]
  50. Maggs D., Shen L., Strobel S., Brown D., Kolterman O., Weyer C. Effect of pramlintide on A1C and body weight in insulin-treated African Americans and Hispanics with type 2 diabetes: a pooled post hoc analysis. Metabolism. 2003 Dec;52(12):1638–1642. doi: 10.1016/j.metabol.2003.06.003. [DOI] [PubMed] [Google Scholar]
  51. Maldonado Mario R., Otiniano Max E., Lee Rebekah, Rodriguez Lucille, Balasubramanyam Ashok. Characteristics of ketosis-prone diabetes in a multiethnic indigent community. Ethn Dis. 2004 Spring;14(2):243–249. [PubMed] [Google Scholar]
  52. McFarlane S. I., Chaiken R. L., Hirsch S., Harrington P., Lebovitz H. E., Banerji M. A. Near-normoglycaemic remission in African-Americans with Type 2 diabetes mellitus is associated with recovery of beta cell function. Diabet Med. 2001 Jan;18(1):10–16. doi: 10.1046/j.1464-5491.2001.00395.x. [DOI] [PubMed] [Google Scholar]
  53. Misbin Robert I. The phantom of lactic acidosis due to metformin in patients with diabetes. Diabetes Care. 2004 Jul;27(7):1791–1793. doi: 10.2337/diacare.27.7.1791. [DOI] [PubMed] [Google Scholar]
  54. Musey V. C., Lee J. K., Crawford R., Klatka M. A., McAdams D., Phillips L. S. Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis. Diabetes Care. 1995 Apr;18(4):483–489. doi: 10.2337/diacare.18.4.483. [DOI] [PubMed] [Google Scholar]
  55. NEEL J. V. Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? Am J Hum Genet. 1962 Dec;14:353–362. [PMC free article] [PubMed] [Google Scholar]
  56. Nathan David M. Clinical practice. Initial management of glycemia in type 2 diabetes mellitus. N Engl J Med. 2002 Oct 24;347(17):1342–1349. doi: 10.1056/NEJMcp021106. [DOI] [PubMed] [Google Scholar]
  57. Ong K. K., Dunger D. B. Thrifty genotypes and phenotypes in the pathogenesis of type 2 diabetes mellitus. J Pediatr Endocrinol Metab. 2000;13 (Suppl 6):1419–1424. doi: 10.1515/jpem-2000-s616. [DOI] [PubMed] [Google Scholar]
  58. Osei K. Metabolic consequences of the West African diaspora: lessons from the thrifty gene. J Lab Clin Med. 1999 Feb;133(2):98–111. doi: 10.1016/s0022-2143(99)90002-1. [DOI] [PubMed] [Google Scholar]
  59. Osei Kwame, Rhinesmith Scott, Gaillard Trudy, Schuster Dara. Beneficial metabolic effects of chronic glipizide in obese African Americans with impaired glucose tolerance: implications for primary prevention of type 2 diabetes. Metabolism. 2004 Apr;53(4):414–422. doi: 10.1016/j.metabol.2003.11.016. [DOI] [PubMed] [Google Scholar]
  60. Osei Kwame, Rhinesmith Scott, Gaillard Trudy, Schuster Dara. Metabolic effects of chronic glipizide gastrointestinal therapeutic system on serum glucose, insulin secretion, insulin sensitivity, and hepatic insulin extraction in glucose-tolerant, first-degree relatives of African American patients with type 2 diabetes: new insights on mechanisms of action. Metabolism. 2003 May;52(5):565–572. doi: 10.1053/meta.2003.50111. [DOI] [PubMed] [Google Scholar]
  61. Palaniappan Latha P., Carnethon Mercedes R., Fortmann Stephen P. Heterogeneity in the relationship between ethnicity, BMI, and fasting insulin. Diabetes Care. 2002 Aug;25(8):1351–1357. doi: 10.2337/diacare.25.8.1351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Paris R. M., Bedno S. A., Krauss M. R., Keep L. W., Rubertone M. V. Weighing in on type 2 diabetes in the military: characteristics of U.S. military personnel at entry who develop type 2 diabetes. Diabetes Care. 2001 Nov;24(11):1894–1898. doi: 10.2337/diacare.24.11.1894. [DOI] [PubMed] [Google Scholar]
  63. Pearte Camille A., Gary Tiffany L., Brancati Frederick L. Correlates of physical activity levels in a sample of urban African Americans with type 2 diabetes. Ethn Dis. 2004 Spring;14(2):198–205. [PubMed] [Google Scholar]
  64. Porter J. R., Barrett T. G. Acquired non-type 1 diabetes in childhood: subtypes, diagnosis, and management. Arch Dis Child. 2004 Dec;89(12):1138–1144. doi: 10.1136/adc.2003.036608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Radhakrishnamurthy B., Srinivasan S. R., Webber L. S., Dalferes E. R., Jr, Berenson G. S. Relationship of carbohydrate intolerance to serum lipoprotein profiles in childhood. The Bogalusa Heart Study. Metabolism. 1985 Sep;34(9):850–860. doi: 10.1016/0026-0495(85)90110-6. [DOI] [PubMed] [Google Scholar]
  66. Reaven G. M. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988 Dec;37(12):1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]
  67. Riddle Matthew C., Rosenstock Julio, Gerich John, Insulin Glargine 4002 Study Investigators The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care. 2003 Nov;26(11):3080–3086. doi: 10.2337/diacare.26.11.3080. [DOI] [PubMed] [Google Scholar]
  68. Rosenson Robert S., Reasner Charles A. Therapeutic approaches in the prevention of cardiovascular disease in metabolic syndrome and in patients with type 2 diabetes. Curr Opin Cardiol. 2004 Sep;19(5):480–487. doi: 10.1097/01.hco.0000133111.66486.c6. [DOI] [PubMed] [Google Scholar]
  69. Rosenstock J., Schwartz S. L., Clark C. M., Jr, Park G. D., Donley D. W., Edwards M. B. Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Diabetes Care. 2001 Apr;24(4):631–636. doi: 10.2337/diacare.24.4.631. [DOI] [PubMed] [Google Scholar]
  70. Saaddine Jinan B., Engelgau Michael M., Beckles Gloria L., Gregg Edward W., Thompson Theodore J., Narayan K. M. Venkat. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002 Apr 16;136(8):565–574. doi: 10.7326/0003-4819-136-8-200204160-00005. [DOI] [PubMed] [Google Scholar]
  71. Schectman Joel M., Nadkarni Mohan M., Voss John D. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care. 2002 Jun;25(6):1015–1021. doi: 10.2337/diacare.25.6.1015. [DOI] [PubMed] [Google Scholar]
  72. Scheen A. J. Management of the metabolic syndrome. Minerva Endocrinol. 2004 Jun;29(2):31–45. [PubMed] [Google Scholar]
  73. Schmidt M. I., Duncan B. B., Watson R. L., Sharrett A. R., Brancati F. L., Heiss G. A metabolic syndrome in whites and African-Americans. The Atherosclerosis Risk in Communities baseline study. Diabetes Care. 1996 May;19(5):414–418. doi: 10.2337/diacare.19.5.414. [DOI] [PubMed] [Google Scholar]
  74. Schuster D., Gaillard T., Rhinesmith S., Habash D., Osei K. The impact of an insulin sensitizer, troglitazone, on glucose metabolism in African Americans at risk for type 2 diabetes mellitus: a placebo-controlled, 24-month randomized study. Metabolism. 2003 Sep;52(9):1211–1217. doi: 10.1016/s0026-0495(03)00160-4. [DOI] [PubMed] [Google Scholar]
  75. Shih David Q., Stoffel Markus. Molecular etiologies of MODY and other early-onset forms of diabetes. Curr Diab Rep. 2002 Apr;2(2):125–134. doi: 10.1007/s11892-002-0071-9. [DOI] [PubMed] [Google Scholar]
  76. Summerson John H., Bell Ronny A., Konen Joseph C., Spangler John G. Differential impact of cardiovascular disease (CVD) risk factor clustering on CVD and renal disease among African-American and white patients with type 2 diabetes mellitus. Ethn Dis. 2002 Fall;12(4):530–534. [PubMed] [Google Scholar]
  77. Svec F., Nastasi K., Hilton C., Bao W., Srinivasan S. R., Berenson G. S. Black-white contrasts in insulin levels during pubertal development. The Bogalusa Heart Study. Diabetes. 1992 Mar;41(3):313–317. doi: 10.2337/diab.41.3.313. [DOI] [PubMed] [Google Scholar]
  78. Thaler L. M., Ziemer D. C., Gallina D. L., Cook C. B., Dunbar V. G., Phillips L. S., El-Kebbi I. M. Diabetes in urban African-Americans. XVII. Availability of rapid HbA1c measurements enhances clinical decision-making. Diabetes Care. 1999 Sep;22(9):1415–1421. doi: 10.2337/diacare.22.9.1415. [DOI] [PubMed] [Google Scholar]
  79. Umpierrez G. E., Casals M. M., Gebhart S. P., Mixon P. S., Clark W. S., Phillips L. S. Diabetic ketoacidosis in obese African-Americans. Diabetes. 1995 Jul;44(7):790–795. doi: 10.2337/diab.44.7.790. [DOI] [PubMed] [Google Scholar]
  80. Umpierrez G. E., Kelly J. P., Navarrete J. E., Casals M. M., Kitabchi A. E. Hyperglycemic crises in urban blacks. Arch Intern Med. 1997 Mar 24;157(6):669–675. [PubMed] [Google Scholar]
  81. Wagh Arati, Stone Neil J. Treatment of metabolic syndrome. Expert Rev Cardiovasc Ther. 2004 Mar;2(2):213–228. doi: 10.1586/14779072.2.2.213. [DOI] [PubMed] [Google Scholar]
  82. Winter W. E. Molecular and biochemical analysis of the MODY syndromes. Pediatr Diabetes. 2000 Jun;1(2):88–117. doi: 10.1034/j.1399-5448.2000.010206.x. [DOI] [PubMed] [Google Scholar]
  83. Winter W. E., Nakamura M., House D. V. Monogenic diabetes mellitus in youth. The MODY syndromes. Endocrinol Metab Clin North Am. 1999 Dec;28(4):765–785. doi: 10.1016/s0889-8529(05)70101-8. [DOI] [PubMed] [Google Scholar]
  84. Yki-Järvinen H. Combination therapies with insulin in type 2 diabetes. Diabetes Care. 2001 Apr;24(4):758–767. doi: 10.2337/diacare.24.4.758. [DOI] [PubMed] [Google Scholar]
  85. Young Bessie A., Maynard Charles, Boyko Edward J. Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans. Diabetes Care. 2003 Aug;26(8):2392–2399. doi: 10.2337/diacare.26.8.2392. [DOI] [PubMed] [Google Scholar]
  86. Young Bessie A., Maynard Charles, Reiber Gayle, Boyko Edward J. Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes Care. 2003 Feb;26(2):495–501. doi: 10.2337/diacare.26.2.495. [DOI] [PubMed] [Google Scholar]
  87. Ziemer David C., Berkowitz Kathy J., Panayioto Rita M., El-Kebbi Imad M., Musey Victoria C., Anderson Lynda A., Wanko Nancy S., Fowke Margaret L., Brazier Carol W., Dunbar Virginia G. A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes. Diabetes Care. 2003 Jun;26(6):1719–1724. doi: 10.2337/diacare.26.6.1719. [DOI] [PubMed] [Google Scholar]
  88. de Rekeneire Nathalie, Rooks Ronica N., Simonsick Eleanor M., Shorr Ronald I., Kuller Lewis H., Schwartz Ann V., Harris Tamara B., Health, Aging and Body Composition Study Racial differences in glycemic control in a well-functioning older diabetic population: findings from the Health, Aging and Body Composition Study. Diabetes Care. 2003 Jul;26(7):1986–1992. doi: 10.2337/diacare.26.7.1986. [DOI] [PubMed] [Google Scholar]
  89. el-Kebbi I. M., Ziemer D. C., Musey V. C., Gallina D. L., Bernard A. M., Phillips L. S. Diabetes in urban African-Americans. IX. Provider adherence to management protocols. Diabetes Care. 1997 May;20(5):698–703. doi: 10.2337/diacare.20.5.698. [DOI] [PubMed] [Google Scholar]

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